Provider Demographics
NPI:1003505702
Name:WEEKLEY, TIMOTHY MARK
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MARK
Last Name:WEEKLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46440 US HIGHWAY ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074
Mailing Address - Country:US
Mailing Address - Phone:440-774-6738
Mailing Address - Fax:440-774-6740
Practice Address - Street 1:46440 US HIGHWAY ROUTE 20
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074
Practice Address - Country:US
Practice Address - Phone:440-774-6738
Practice Address - Fax:440-774-6740
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician